RESUMO
BACKGROUND: We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor. MATERIALS AND METHODS: Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention. RESULTS: In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia. CONCLUSION: Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n't make more parturient and neonatal side-effects.
RESUMO
BACKGROUND: Because the effects of cricoid pressure (CP) on BIS values have not been evaluated, this prospective study was designed to assess the BIS values after application of CP in adult patients during the routine induction of general anesthesia. METHODS: We randomly allocated 70 patients (ASA-I) aged 18-64 years, listed for elective surgery into two groups of cricoid (CP) and non-cricoid (nCP). In the cricoid group, bimanual cricoid pressure was performed after the induction of anesthesia and in the nCP group, simple placement of hands without exerting pressure was performed. Arterial blood pressure, heart rate and BIS were measured and recorded immediately before and after application of cricoid pressure, before laryngoscopy and intubation and then every one minute after intubation until 4 minutes. The data were compared between and within groups using the mixed-design analysis of variance. RESULTS: One minute after application of cricoid pressure and before laryngoscopy, BIS showed significantly higher value compared with the nCP group. Furthermore, one min after intubation, BIS values and arterial blood pressure in-creased significantly in both groups compared with the baseline values, but the increase in BIS value was more signifi-cant in CP group than nCP group. Moreover, BIS values increased significantly 2 minutes after intubation in CP group compared with nCP group. CONCLUSIONS: It was concluded that the application of CP in combination with laryngoscopy and intubation increases the BIS values, which show the inadequacy of anesthesia and hypnosis during the routine induction of anesthesia.
